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October 5, 2011

I had eyelid surgery 8 days ago and I am certain that my surgeon made a mistake. What should I do?

Filed under: blepharoplasty,cosmetic eyelid surgery,eyelid reconstructive surgery,Eyelid Surgery,fixing eyelid surgery,oculoplastic surgeon,oculoplastic surgery — Tags: , , , , , — admin @ 7:53 pm

Blepharoplasty is an invasive surgical procedure and by definition, requires time to heal.  Eye surgery causes trauma to the tissue surrounding your eyes and it’s difficult to determine how your eyes will look, even after a week or more.  In the grand scheme of things, eight days is not enough time to determine the majority of mistakes.  Even if your doctor did cause a complication, it’s possible it will clear up during the healing process.  However, there are some rare complications to be mindful of and consult your physician immediately if you are experiencing the symptoms.

Immediate post-operative issues

Dr. Steinsapir uses the term “immediate” to describe post-operative issues and complications that last from moments after surgery to up to six months, whereas long-term complications are issues that persist for more than six months.  He uses the six month time frame because a number of concerns related to upper eyelid crease height, difficulty closing the eye, mild lower eyelid retraction or alterations in eyelid shape often resolve spontaneously within this time period.

Dry eye

One of the most common problems after surgery is dry eye.  Swelling and temporary lid dysfunction can exacerbate pre-op dry eye issues.  When the eyelids are swollen after surgery, they do not move the tears around very well and this can cause drying and irritation.  This type of swelling can typically affect eye comfort for ten days or more when there is normal tear production.  When the eyes are dry, eye comfort may be affected by post-operative eyelid swelling for several weeks before resolving.

If, however, the surgery damages the nerve fibers that supply the muscle that closes the eye (orbicularis oculi muscle), the blink mechanism may be permanently affected causing long-term eye surface drying and dry eye symptoms like irritation, sensation of burning, grittiness, and redness. Fortunately, many of these closure issues get better over time. You can treat these dry-eye symptoms with artificial tears and bland ophthalmic ointment.  Additionally, Dr. Steinsapir may choose to supplement this by plugging the tear drainage system, and taping the eyes closed.

Bruising

Bruising is natural and anticipated following surgery; it is a normal part of recovery.  On rare occasions, a much more significant bruise can occur. If this happens deep behind the eye, the bruise can cause blindness. This type of bleeding is called a retro-orbital hemorrhage.  While these cases are very rare, it is this very significant risk that prompts the eyelid surgeon to advise potential patients to avoid medications and herbal products that can thin the blood and predispose to bruises in the first place.

Bleeding that causes bruising after surgery can occur from straining, coughing or other activities that disrupt the clots that normally form from the surgical wounds.  For this reason, it is essential for your potential eyelid surgeon to know if you are taking a blood thinner such as aspirin, coumadin, or Plavix.  In these circumstances, Dr. Steinsapir will advise against elective or optional eyelid surgery.

Superficial bruising may not threaten vision but these bruises can affect the outcome of surgery.  Severe bruises cause swelling that can stretch a healing eyelid. In the upper eyelid, this can produce heaviness in the upper eyelid that might need to be corrected surgically if there is no resolution after 6 months.  When the resulting eyelid malposition does not satisfactorily resolve by 6 months after surgery, revisional surgery may be necessary to address the issue.

Stitches

Occasionally, stitches closing the surgical incision come apart before the skin edges are healed together.  This is called a wound dehiscence.  This most commonly occurs in the upper eyelid where an incision is made to remove excess skin. The raw edges of skin separate and the wound gapes open. This can be unsightly and it is tempting to sew the raw edges back together. This may be the right thing to do, however, there may be a low-grade infection causing the wound separation in which case the best course of action is to simply observe the area, and keep it moist with extra antibiotic ointment. The most surprising thing about wound dehiscence is how well it heals on its own. It has been Dr. Steinsapir’s experience that given time to fully heal, the body pulls the skin edges back together so well that no further intervention is needed.

Swelling

Chemosis is a specific type of tissue swelling. The white of the eye is a specialized tissue called the conjunctiva.  Just like the eyelids can swell following surgery, the conjunctiva can also swell.  It looks like jelly along the edge of the eyelid. Mild chemosis is self-limited; it will resolve on its own.  More severe chemosis is very rare and is almost never seen with standard blepharoplasty.  In this circumstance, the swollen conjunctival tissues balloon to the point where they are not covered by the closed eyelids. When this happens, the conjunctiva is subject to drying that causes more swelling―becoming a cycle.  The best treatment is aggressive lubrication with an ophthalmic ointment and when necessary, occlusion with plastic wrap to prevent drying. Surgical treatments are available for the rare instances when these measures are insufficient.

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology.  Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA.  Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

August 27, 2011

My surgeon performed eyelid surgery 6 weeks ago and now my eyes don’t close at night. What should I do?

Filed under: blepharoplasty,eyelid reconstructive surgery,Eyelid Surgery,oculoplastic surgeon,oculoplastic surgery — Tags: , , , , , , — admin @ 10:39 am

Eyelid surgery is a delicate operation that has as many rewards, but it is still surgery and requires adequate healing time.  As you begin to heal, you may notice problems with dry eyes, or your lids not closing properly.  Immediately after surgery and for about ten days following, swelling may cause discomfort and concern about the new position of your lids.  However, as your body heals, your lids may resume a more natural position.  There is a small risk that the nerve fibers that supply the muscle that closes the eye (orbicularis oculi muscle), may be temporarily or permanently weakened causing long-term eye surface drying and dry-eye symptoms.  Six weeks following surgery is too early to become alarmed, but Dr. Steinsapir strongly recommends visiting your original surgeon for a complete assessment of your condition to determine your treatment options. If your surgeon is not a fellowship trained oculoplastic surgeon, you may need to see one or a cornea specialist.

Why won’t my eyes close?

Surgery can produce long-term damage to the function of the eyelids causing dry eye symptoms.  If your surgeon removes too much upper eyelid skin and underlying muscle, your eyes may not close completely, causing dry spots to develop on the cornea.  Depending of the design of the blepharoplasty, the nerves that supply the muscle that helps to close the eye can be damaged weakening the blink reflex.  This means that during a blink there may not be sufficient speed or force to cause the upper and lower eyelids to meet during the blink.  Since the eyelids move tears on the eye surface around, the net result is surface drying.

What are my treatment options?

The first line approach to treating these issues is to increase the frequency of artificial eye drops and, when indicated, ophthalmic ointment at bedtime.  If necessary, your tear drains in your eyelids can be closed temporarily with plugs to see if symptoms improve.  If these measures fail, there are some additional mechanical measures available.  Depending on the corneal status early surgical reconstruction may be necessary.

The extent of the solution depends on the severity of the symptoms and the degree of drying seen on the surface of the cornea.  Although a range of options are available, the key objective is to make the eyelids meet and to create sufficient force of eyelid closure to help spread the tears over the corneal surface.

Is this a long-term issue?

Common post-operative issues can be thought of in two broad categories: immediate and long term.  Immediate issues are post-operative issues and complications that present anytime from moments after surgery up to six months.  Long-term complications are issues that continue to persist beyond six months.  The six-month time frame is useful because a number of concerns related to difficulty closing the eye and mild lower eyelid retraction often resolve spontaneously in this time frame.  In contrast, it is Dr. Steinsapir’s experience that when these types of problems are present six months after surgery and continue to be a concern, then they often need to be addressed with a corrective surgery.

I chose an experienced surgeon, what happened?

No matter how technically superb the surgeon, surgery can tip a marginally compensated dry eye to discomfort.  Unpredictable individual factors may also contribute to a particular situation.  Dr. Steinsapir is acutely aware of the importance of eye comfort after surgery and what steps are needed to make the eye as comfortable as possible. Unfortunately, specialists lacking the training in Ophthalmology can underestimate the impact of these easily addressed issues.  For this reason, Dr. Steinsapir closely follows his patients after surgery.  Your post-operative follow-up schedule is based on how you are actually doing rather than on a scheduled based on how everyone one else has done in the past.

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

August 6, 2011

Can I visit the United States for Reconstructive Surgery?

Filed under: blepharoplasty,cosmetic eyelid surgery,Cosmetic Surgery,Dr. Steinsapir,eyelid cancer reconstruction,eyelid reconstructive surgery,facial cosmetic surgery,fixing eyelid surgery,oculoplastic surgeon,oculoplastic surgery — Tags: , , , , , , — admin @ 9:32 am

When it comes to reconstructive facial surgery, Dr. Steinsapir has extensive experience with eyelid, midface, and orbital reconstruction including repair of prior unsatisfactory eyelid surgery, removing unsatisfactory facial implants, correcting eye changes associated with thyroid eye disease, orbital and tear duct surgery, and repair of the eyelid after skin cancer removal or trauma.

Many people travel from across the United States as well as internationally to have surgery with Dr. Steinsapir.  He is world-renowned for his leadership in facial cosmetic surgery.  If you are considering traveling to have reconstructive surgery or other cosmetic treatment with Dr. Steinsapir, here are some important considerations that will help you have the best experience possible.

Consult First

Many people who travel for cosmetic treatment feel they should be able to have surgery at the time of their initial consultation.  They want to take care of everything in just one trip, so they may fly or make a long drive to Los Angeles, have their consultation, and have surgery all during the same trip.  This idea may seem appealing because you only have to book a flight and pack your suitcase once, and you may even save a little money—but please reconsider this approach.  Dr. Steinsapir doesn’t believe in performing an initial consultation and surgery at the same time.  Even if you save a few dollars in airfare, in the end this amounts to hasty and high-pressure decisions.  Your choice to move forward in having surgery with the right doctor is important, and it’s not a good idea to cut corners here.

Reconstructive surgery should be something you and your surgeon approach calmly, thoughtfully, and with confidence.  Instead of too much pressure, Dr. Steinsapir strongly advises and encourages you to take the time to make sure you have found the right doctor and right treatment approach.  He wants you to have time to think about the options and be completely comfortable with the proposed surgical plan.

Take Time to Reflect

Consulting now and having surgery later is a sound approach for anyone seeking the right cosmetic treatment with any doctor.  Although admittedly not convenient, slowing down, thinking about your choices and being fully comfortable ensures that you can make a fully informed choice without the pressure of time.  When you consult with Dr. Steinsapir, he won’t pressure you into committing to surgery.  It is better for everyone if you have the opportunity to meet with the surgeon, then have time to think about the issues discussed well before undergoing reconstructive surgery.

Make Thoughtful Decisions

Even if you’re traveling from very far, Dr. Steinsapir will not perform surgery at the time of your initial consultation.  The best surgery is always performed with the utmost of care, consideration, research, and planning.  You should go into surgery comfortable and confident that you have made the right decision.

About Dr. Steinsapir

Dr. Steinsapir is on active staff at the UCLA Hospital and Medical Center at the David Geffen School of Medicine as an associate clinical professor of Ophthalmology in the Division of Orbital and Ophthalmic Plastic Surgery. UCLA is consistently rated the best hospital in the West and ranked third among all medical centers in the United States. Many surgeries are performed on an outpatient basis at the Surgery Center at the UCLA Medical Center. Larger procedures may also be performed on an inpatient basis at the Jules Stein Eye Institute. Dr. Steinsapir addresses a broad array of oculofacial reconstructive concerns.  Contact us today to schedule a consultation, followed by a brief consideration of the more common reconstructive issues that bring people to see Dr. Steinsapir.

June 29, 2011

Complications after surgery

Filed under: beverly hills facelift,blepharoplasty,cosmetic eyelid surgery,Cosmetic Surgery,eyelid reconstructive surgery,Eyelid Surgery,lower blepharoplasty,midface lift,midface surgery,oculoplastic surgeon — Tags: , , , , , , — admin @ 7:53 am

Complications following a midface lift and eyelid surgery are especially disconcerting because they can affect the basic functions of your eyes.  Whether your eyes begin to droop, tear, or fail to blink, any change in the way your eyes and face function is reason to be concerned.  But sometimes, inexperienced surgeons panic in these situations (even long-in-practice, but inexperienced surgeons) and respond with a shoot-from-the-hip, fix-it mentality, and may push you to undergo corrective surgery immediately.  Your surgeon may just want to take care of the problem as quickly as possible and as a result, you may feel pressured to have a corrective surgery.  There are certainly times where immediate work is appropriate.  Before you agree to such a fix, ask yourself if you are still comfortable trusting your surgeon.  In his book Blink, Malcom Gladwell describes the process of “thin slicing;” the way our intuition rapidly assesses a situation.  That intuition is ignored at our peril.  If the hair on the back of your neck is standing up because your surgeon wants to hustle you back to surgery, ask yourself: are you comfortable with what is being proposed?  If you are not comfortable, your best course of action is the natural one―dig in your heals.  There are occasional situations that are medical emergencies.  However, these are truly rare.  There is almost always time for a second opinion.

Undergo a consultation

Before taking any action to correct your complications, carefully weigh your confidence in your current surgeon.  There is no substitute for an in-depth personal consultation because discussing your problem with your doctor over the phone doesn’t allow him or her to see, and fully understand the physical complications.  Occasionally, the description of what is going on and the actual physical complications are not the same.  Fixing complications is specialized business.  Even if your surgeon does a lot of primary cosmetic surgery, he or she may be relatively unsophisticated when it comes to repairing surgical complications, especially when this work affects the function of the eyelids.

If you are not 100 percent confident in your surgeon and are casting about for opinions from strangers, listen to your feelings.  Do not blindly follow the recommendations your original surgeon or any surgeon whose recommendations do not make sense to you.  Don’t commit to a second surgery unless you have a clear understanding of the following:

  • What is going on and why these complications are occurring,
  • What type of surgery your doctor has planned,
  • Why a surgical solution is necessary,
  • The risks of a second surgery, and
  • The probability of success or failure.

The risks of midface and lower eyelid surgery and corrective surgery

Lower eyelid surgery and midface surgery have significant risks associated with them.  Your surgeon may not fully understand these risks.  If you’re experiencing complications it does not mean that your surgeon did something that another surgeon might have done in a similar circumstance.  However, how your surgeon addresses the problem can make a profound difference and he or she should not rush the process.

The anatomy described in some of the most important and most recent papers in the field of lower eyelid and midface surgery done through a skin incision under the lower eyelashes (infracillary incision) is inaccurate.  Dr. Steinsapir recently reviewed the literature on this subject and presented it before the Fall 2010 American Society for Ophthalmic Plastic and Reconstructive Surgery Scientific Symposium.  Some of the core papers describe anatomic hypotheses rather than proven anatomic fact.  Unfortunately, a hypothesis is a scientific guess―it does not make an established anatomic fact. Lower eyelid surgery through the lower eyelid skin is one example of this.  Surgery damages the motor nerves that help support the lower eyelid margin leading to complications that can surprise the unsuspecting surgeon.  Naturally, they are not going to say that they are surprised but be assured they would not perform surgery this way if they thought it would cause a problem.

So why do doctors still perform this kind of surgery despite the risks?  Despite the inaccurate papers it is possible to dissect in this plane in some cases without significantly altering the nerve supply to the orbicularis oculi muscle.   Motor nerve damage to the orbicularis oculi muscle near the upper and lower eyelid margin affects the blink and weakens eye closed.  Without this critical blink function, tears do not move across the corneal surface properly resulting in dry eye and tearing issues.  When the lower eyelid slumps, it does not properly cover the lower portion of the eye and there is increased corneal drying.

The remedy for midface and lower eyelid surgery complications

To address eyelid complications from a midface lift or lower lid surgery, the best answer is to avoid further eyelid tightening and allow the tissues to heal.  By preserving as much of the lower eyelid function and not cutting out additional tissue―as would be the case if your doctor were to try to fix the problems immediately following your initial surgery using a technique called canthoplasty―there are many more options and increased likelihood of an improved outcome if you allow the tissue to heal.  While in the healing process, keep lines of communication open with your surgeon or look for oculoplastic surgeons for consultation who have as a focus of their practice the repair of unsatisfactory cometic eyelid surgery.  Be skeptical of solutions that must be done “urgently” or don’t make sense.  While very few of these complications mend themselves, with time it may improve so less work than originally  thought may be necessary.

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.

May 10, 2011

Do I need an eye examination before I have eyelid surgery?

Filed under: canthal surgery,cosmetic eyelid surgery,cosmetic surgery and insurance,cosmetic treatment payment,oculoplastic surgeon — Tags: , , , — admin @ 7:43 pm

Cosmetic surgery clients often wonder what type of examinations they need prior to undergoing eyelid surgery.  It’s important for your surgeon to give you a physical examination to fully understand your expectations, your anatomy, and any current health issues before any cosmetic surgery procedure.  Before eyelid surgery, the same considerations apply.  A detailed assessment of your eye and eyelid health should be performed in advance of eyelid surgery.  This information is essential for your surgeon to understand your eye health and how it might be affected by eyelid surgery.

Insurance coverage for eyelid surgery

Insurance companies including Medicare have significantly restricted which eyelid procedures they will cover.  In the past, coverage was much more generous; now coverage is greatly limited.  Even functionally significant issues may be denied.  Many of our patients, upon investigating co-pays and deductibles are surprised to learn that, in some cases, they actually save money by paying out-of-pocket for certain eyelid procedures as cosmetic surgery.  Every situation is different, but it’s worth researching the charges you will be responsible for if you use applicable health insurance.  It can sometimes be less expensive to pay for your procedure out-of-pocket because often, the rates for medically necessary surgery are much higher than the cosmetic rates.  This difference can be particularly acute if you have a high-deductible insurance policy and you have not met your deductible limits.  If your issue is not medically necessary, convincing your doctor to submit a false insurance claim is a crime.  Just because you know someone who had eyelid surgery covered by health insurance, don’t assume you have the same issues.

Finding a highly qualified eyelid surgeon

The best course of action is to seek care from a fellowship-trained oculoplastic surgeon.  Oculoplastic surgeons are board-certified ophthalmologists who have completed a two-year fellowship in eyelid and facial plastic surgery.  They have the necessary experience and equipment to examine you and document your issues.  If your problem requires surgery to help improve you quality of life and likely covered by health insurance, your oculoplastic surgeon will inform you of this.  On the contrary, if it is not covered, please respect the surgeon’s opinion.  For a list of names of qualified oculoplastic surgeons in your area, visit ASOPRS.org.  This is the website for the American Society for Ophthalmic Plastic and Reconstructive Surgery and it features a geographic directory.

Cosmetic eyelid surgery

As with any surgical procedure, elective or otherwise, it’s important to find a surgeon who will perform an appropriate consultation.  If you’re undergoing revisional surgery with a new surgeon, one who did not perform the original surgery, bringing pre-surgery photographs and any medical records to your examination will help your new surgeon create a treatment plan that will result in the changes you desire.  The new surgeon may ask that you release you prior medical records for review before your visit.

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology.  Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA.  Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

March 19, 2011

Who can inject BOTOX®?

Filed under: Beverly Hills BOTOX,Botox,Botox Los Angeles,Cosmetic Surgery,Dr. Steinsapir,Microdroplet BOTOX,oculoplastic surgeon,oculoplastic surgery — Tags: , , , , , , — admin @ 8:32 pm

The short answer to the question of who can inject BOTOX® is: any licensed medical doctor or any nurse under the direct supervision of a licensed medical doctor.  The exact details of the required qualifications vary by State so it’s important to research the individual you wish to perform the injection to ensure he or she is qualified.  However, just because your doctor or nurse is minimally qualified to perform the injection does not necessarily indicate he or she is the ideal candidate for the procedure. As with many other medical procedures, ideal results require a certain level of qualification, skill and experience; these concerns are perhaps even more important when considering modifications to your physical appearance.

Nurses

Most States do not allow the independent practice of nurses performing BOTOX injections.  The presence of a “Medical Director,” in name only, is no substitute for a personal examination by a supervising physician on the premises when you are treated by a nurse. It has become common to see nurses injecting clients at beauty salons.  They might also suggest that they are supervised by a “medical director.”  In the State of California for example, registered nurses are only permitted to inject under the immediate supervision of a licensed physician.  The physician needs to have performed an examination and be physically present in the same office where the treatment is taking place.

When seeking a professional for this procedure, talk to the doctor to determine who will perform the procedure, what their qualifications are, if they have undergone specialized training, and how much experience they have performing the injections.  If you don’t feel comfortable with the prospect of the nurse or the doctor performing the injections, it’s time to look for someone new.

Dr. Steinsapir never uses nurses or “physician extenders” to treat you.  He personally performs all treatment himself.  Don’t be fooled into thinking that cosmetic treatments are simple enough to be performed by an assistant under supervision.  Dr. Steinsapir, like all reputable surgeons, makes sure that he is available to answer your questions in person and address your concerns individually, rather than directing you to a receptionist or simply brushing you off.  He can individualize your treatment plan to help you meet your personal goals.  Have treatment at the time of your consultation if it is right for you.

Dentists

Most States do not permit general dentists to inject cosmetic BOTOX.  However, dentists who hold a dual, MD and DMD degree sometimes perform cosmetic BOTOX injections.  These individuals are often highly trained Maxillofacial surgeons with residency training in Maxillofacial surgery.  It is misleading to simply describe these individuals as “dentists.”  Check with the licensing board for your State to learn what is, or is not permitted.  When it doubt, remember, that there is no substitute for experience in performing these treatments.

The right doctor for the job

When seeking a medical professional for BOTOX injections, board certification in one of the four core aesthetic specialties is usually a good place to start: Dermatology, General Plastic Surgery, Facial Plastic Surgery, and Oculoplastic Surgery.  Board certified professionals in one of these four specialties undergo rigorous and extensive training and have a wealth of experience working with BOTOX.  Especially when seeking cosmetic injections in the facial regions, look for someone who understands the importance of adapting treatment for a given face.

Beginning your search with board certified professionals will greatly reduce the number of unqualified professionals you interview.  Look for someone with the skills and experience to provide satisfactory results that make you happy.

About Dr. Steinsapir

Dr. Steinsapir trained alongside the inventor of BOTOX® and has performed thousands of BOTOX® treatments in Los Angeles since 1988.  He is a board certified eye surgeon and fellowship trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology.  Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of  Medicine at UCLA.  Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert provider of BOTOX, which can be a vital part of your evidence-based treatment plan.

February 16, 2011

What are the new alternative methods of treating basal cell carcinoma?

Filed under: Cosmetic Surgery,eyelid reconstructive surgery,Eyelid Surgery,Mohs cancer surgery,oculoplastic surgeon — Tags: , , , , — admin @ 2:47 am

Basal cell carcinoma is the most common form of skin cancer, and fortunately with early diagnosis and treatment basal cell carcinoma of the eyelid has a great outlook and is seldom fatal.  Treatment is necessary. It is ideal to have care by a coordinated team of specialists who can each help you to manage optimal treatment.  With multiple treatment options available, how do you know which is right for you to pursue?  This will depend on your individual situations and insight from your doctor.  Educating yourself on your condition and treatment options is also of great value.

In the vast majority of situations, treatment is surgical and starts with a diagnosis that requires a biopsy of a nonhealing growth of the skin.  This can be performed by a dermatologist, plastic surgeon, or facial plastic surgeon.  When the growth is on the eyelid, you may be referred to an oculoplastic surgeon for this biopsy.  Many lesions can be directly excised with excellent outcomes.  Then the basal cell carcinoma involved important structures of the face, Mohs’ cancer surgery is the preferred method of excising the skin cancer because it has a high cure rate and preserves the most uninvolved skin.  This makes for better preservation of form and function following reconstructive surgery.  Depending on the complexity of the reconstruction, the wound might be repaired by the Mohs’ surgeon or it might require the specialized surgical skill of the oculoplastic surgeon, facial plastic surgeon, or general plastic surgeon depending on the precise nature of the defect.  Cure rates following successful Mohs’ surgery can exceed 95%.

There are some novel non-surgical treatments under study for treating basal cell carcinoma, including hedgehog pathway drug and Imiquimod, which are promising medical developments but we still need to further study and better understand them in order to develop their best medical application.

Hedgehog Pathway Drug
The hedgehog signaling pathway is active in human embryogenesis and plays a key role in proper growth and development during our earliest stages; but in adults this pathway is inactive.  Researchers have found that the signaling pathway is active in certain tumors where it promotes a micro-environment that favors tumor growth.  Sporadic mutations in the active hedgehog pathway appear to account for the majority of spontaneously occurring basal cell, ovarian, colon, and pancreatic carcinomas.

This pathway can be suppressed, which provides hope for a new cure for basal cell carcinoma.  GDC-0449 is a drug that is active in suppressing this pathway, and it is currently under development from Genetech.  Treatment with this drug appears to provide promise for advanced forms of basal cell carcinoma that are beyond surgical cure with eyelid or orbit surgery.  As with many medical drugs, there are associated side effects, and clinical evaluations are still in progress to help us learn more about this new approach.  Since we have already found that GDC-0449 can induce a temporary regression in advanced basal cell carcinoma, it may offer the possibility of prolonging survival in the most advanced cases.

Imiquimod
Imiquimod, also known under the trade name Aldara, is an immune response modifier that was approved by the FDA for dermatological use in 1997.  It has been used to treat a variety of superficial skin malignancies including basal cell carcinoma, squamous cell carcinoma, superficial malignant melanomas, and genital warts.  Researchers and doctors still do not completely understand the actual mechanism of how this drug functions, and ongoing studies are working to answer these questions.  Treatment with Imiquimod involves applying the treatment to the affected skin to provide an anti-proliferative effect on these skin cancers.  Unfortunately, side effects of the drug can cause skin breakdown, ulceration, crusting, and blisters.  However, these symptoms are only temporary and the skin heals remarkably well once the medication is stopped.  The rates of cure for this method are less than that of Mohs cancer surgery, but the Imiquimod is a good alternative for diffuse superficial skin cancers and actinic keratosis, which is a precursor of squamous cell carcinoma.

While these treatments are under investigation, more traditional treatment methods remain effective and appropriate for many basal cell carcinomas.  These include Mohs surgery, simple excision, cryotherapy, and radiation therapy:

Mohs Surgery

Mohs cancer surgery with reconstruction continues to be the gold standard for treating basal cell carcinoma of the eyelids.  This treatment option, named after general surgeon Frederic Mohs who developed the life-saving medical procedure, involves a team approach and microscopic examination of the excised tissue.  This method has a very high cure rate and preserves the most amount of normal eyelid tissue.  Immediately following the removal of the skin cancer, your eyelid reconstruction should be performed.

Simple Excision
Surgeons have found that a simple escision is very effective for localized basal cell carcinoma.  By taking a margin of normal tissue around the lesion, it is possible to completely excise the skin cancer.  Mohs surgery usually incorporates this approach into a comprehensive treatment.

Cryotherapy
Cryotherapy is a method that freezes the basal cell carcinoma with liquid nitrogen.  This method can be effective for small lesions but requires monitoring of the treated area due to the risk of reoccurrence.  This approach is considered on a case-by-case basis and is something to discuss with your doctor to find out whether you are a candidate.

Radiation Therapy
Radiation therapy is effective, but it is associated with reoccurrences and can cause local tissue damage to the surrounding tissue.  However, for select circumstances and individuals, this can be an appropriate treatment option.

All of the treatment methods outlined here should be considered on an individual basis with an experienced doctor who will help you receive the best treatment for you.  For many people, eyelid surgery is an important part of treatment for basal cell carcinoma, which is why an eye plastic surgeon often plays a very important role in your recovery.

About Dr. Steinsapir
Dr. Steinsapir is a much sought after oculofacial surgeon.  He is an innovator in minimally invasive cosmetic and reconstructive procedures and has invented new methods for treating with BOTOX, Fillers and cutting edge facial surgery.  He specializes in high precision eyelid surgery and is a leader in correcting prior facial and eyelid surgery, including prior cancer reconstruction.  He attended medical school at the UCLA and completed ophthalmology residency at The University of Chicago.  He is multiple fellowship trained including three years of fellowship training in oculofacial plastic surgery at UCLA, and a two year cosmetic surgery fellowship in Rancho Mirage.  He is widely published and lectures to other surgeons nationally and internationally.  He is an associate clinical professor of Ophthalmic Plastic and Reconstructive Surgery at the Jules Stein Eye Institute at UCLA.  His private practice is located in West Los Angeles, immediately serving the Los Angeles and Bevery Hills communities.  Additionally, individuals from all over the country and the world regularly come to Los Angeles for this expert care.

February 2, 2011

What are the best lower eyelid options for Asians?

Filed under: asian eyelid surgery,blepharoplasty,Cosmetic Surgery,Eyelid Surgery,oculoplastic surgeon,oculoplastic surgery — Tags: , , , , — admin @ 2:02 am

In every instance of lower eyelid surgery for Asian eyes, the best option is simple yet not easy: the best lower eyelid surgery is one that is custom-designed and skillfully delivered based on your unique circumstances, treatment goals, and individual features.  While it is tempting to seek out a solution that works every time for every person, the nature of facial aesthetics makes it impossible for any standardized medical approach to meet everybody’s needs.  A cookie-cutter or assembly-line approach to eyelid surgery and other kinds of facial cosmetic surgery tends to yield results that don’t look natural to your features and instead represent the “surgical look.”

Lower eyelid surgery before and after photo

Lower eyelid surgery before and after photo

Asking  questions like “What is the best Asian eyelid surgery?” is like asking what shoe size is best to wear.  Of course there are many sizes of feet just as there is great diversity in Asian eyelid features, so your best option must be fit precisely for you alone.  This means that even if your friend had amazing Asian eyelid surgery results, you may benefit from a completely different oculoplastic surgery.  The key to finding the right Asian eyelid surgery for you—be it Asian blepharoplasty, Asian canthoplasty, or another specialized eyelid surgery—lies in finding an exceptional oculoplastic surgeon with specialized training and experience in Asian eyelid surgery and whose treatment philosophy is to custom-design a minimally-invasive treatment that enhances your natural qualities.

A Variety of Helpful Cosmetic Options

In your search for the right lower eyelid surgery for you, you’ll come across many options that you should carefully and considerately discuss with a top cosmetic surgeon.  Lower eyelid surgery options include blepharoplasty, canthoplasty, eyelid reconstruction, midface options, and treatment of dark circles under the eyes.  Even these specific procedures do not follow a standard blueprint for every eyelid; rather, optimal results are always due to custom-tailoring of the treatment to meet the unique circumstances and enhance your eyelid contour in a way that makes sense for you.

The Right Oculoplastic Surgeon for You

Asian eyelid surgery is a specialized subtype of cosmetic eye surgery, and your doctor absolutely needs to have proven experience and success in helping individuals with Asian eyes to achieve the natural results they desire.  This ability in a doctor is accompanied by the understanding that you have unique eyes, and your treatment plan must reflect this uniqueness.  The goal should never be to “westernize” the eyelid, but to design a minimally invasive treatment approach combined with a high level of skill to obtain results that fit you like a fine-tailored suit.

Consider how Dr. Steinsapir’s extensive experience and education in specialized eye plastic surgery can help you to obtain the best Asian eyelid surgery results.  Dr. Steinsapir is both an oculofacial and cosmetic surgeon with board certification in the field of ophthalmology and a tradition of excellence.  Take a look at his eyelid surgery before and after photos, and consider how his education at UCLA and the University of Chicago as well as multiple fellowships and focused practice can help you finally get the natural improvement you seek.  Please contact us today to learn more at your no-risk consultation.

January 14, 2011

Dr. Steinsapir’s Microdroplet™ BOTOX® Patent Officially Approved

Filed under: Botox,Botox Los Angeles,Dr. Steinsapir,facelift alternative,Microdroplet BOTOX,oculoplastic surgeon — Tags: , , , , — admin @ 11:17 am

The United States Patent and Trademark Office has officially issued a rare patent (US 7,846,457 B2) to Dr. Kenneth D. Steinsapir for his Microdroplet™ botulinum toxin (BOTOX®, Dysport®, Xeomin®) method.  The Microdroplet method of administering cosmetic botulinum toxin is a breakthrough invention that revolutionizes the way we think about BOTOX® treatments.

Microdroplet BOTOX Before and After Photo

Microdroplet BOTOX Before and After Photo

Microdroplet™ BOTOX® is an enhanced and now-patented method of administering cosmetic botulinum toxin, most commonly referred to simply as BOTOX®, to individuals who seek cosmetic facial improvement with minimal risk of side effects.  To achieve natural results without the “bat face” or “forehead freeze” sometimes associated with BOTOX®, Microdroplet™ BOTOX® relies on highly controlled placement of tiny microdroplets of botulinum toxin to balance out the give-and-take of the muscles pulling around the eyebrows and causing the all too familiar pinching and frown lines.

What are the benefits of Microdroplet™ BOTOX®?

The result of the precise and balanced placement of your Microdroplet™ BOTOX® treatment is that you can attain natural-looking results that balance your facial features while avoiding the side effects that we more often see with traditional BOTOX treatments.  While there is a chance with any cosmetic procedure that you will not be completely satisfied with your results, Microdroplet™ BOTOX® can maximize your chances for an ideal outcome by relaxing overactive facial muscles and emphasizing your youthful features.

Who is a candidate for Microdroplet™ BOTOX®?

Microdroplet™ BOTOX® is especially recommended for high-profile professionals such as executives, actors, and other individuals who seek a polished aesthetic during their daily interactions with people.  Microdroplet™ BOTOX® preserves natural forehead movement and expression without the all-to-familiar frozen appearance that has become the hallmark of getting treatment with BOTOX® using traditional injection methods.  The relaxed and lifted eyebrows with preservation of forehead movement sets this treatment apart form other methods and has made Dr. Steinsapir’s office the place to go for the most exclusive BOTOX® treatment available.  Those who wish for a younger look with reduced wrinkles, frown lines, and crows feet will want to checkout Microdroplet™ BOTOX®.

How was Microdroplet™ BOTOX® invented?

Dr. Steinsapir has been administering BOTOX treatments since 1988, and he explains, “Early on I recognized the need for an improved approach to cosmetic treatment by carefully listening to the concerns of my patients.  Natural outcomes are vital to a successful and satisfying cosmetic treatment experience.”

In his search for the best treatment, Dr. Steinsapir observed and listened to his patients before and after their BOTOX treatment, and from there he carefully researched and innovated the now-patented Microdroplet™ BOTOX® method in 2006.  Dr. Steinsapir adds that “Microdroplet BOTOX can improve the appearance because it works on select muscles to attain and improve overall facial balance.  It’s an important option for individuals who seek cosmetic improvement without surgery and an essential alternative to current treatment methods.  There is little doubt that this new method will become the predominant method for administering botulinum toxin.”

Who is authorized to provide treatment with Microdroplet™ BOTOX®?

At this time Dr. Steinsapir, the inventor of Microdroplet™ BOTOX®, is the only individual who performs Microdroplet™ BOTOX® treatment.  Dr. Steinsapir is a board certified ophthalmologist specializing in oculofacial and cosmetic surgeon, and an associate clinical professor of ophthalmology at the David Geffen School of Medicine at UCLA.  His practice is located in Beverly Hills, California, and individuals fly here from across the United States and world to benefit from his exceptional patented Microdroplet™ BOTOX® as well as expertise in other minimally invasive cosmetic facial treatments.  For more information on how Dr. Steinsapir’s innovative, forward-thinking treatments focused on natural results can help you, please contact us today.

November 10, 2010

Ptosis and the Asian Eyelid

Filed under: asian eyelid surgery,best cosmetic surgeons,blepharoplasty,cosmetic eyelid surgery,Eyelid Surgery,oculoplastic surgeon,oculoplastic surgery — Tags: , , , , — admin @ 12:27 pm

Eyelid ptosis is a relatively common concern for which effective treatment is available.  The key is in finding a specialist who understands the condition, has a great deal of experience in treating ptosis with successful results, and will custom-design the treatment to fit your unique features to give results that look natural for you.  When you have Asian eyes, all of the above is true, and you must also make certain that your potential oculoplastic surgeon appreciates the unique qualities of your eyes that make you you.  Asian eyelids are as diverse as any other descriptive characteristic for eyelids, so be certain that your physician recognizes the importance of approaching your treatment not through a standard plan, but with your individual circumstances in mind.

Asian eyelid surgery is a specialized type of eyelid surgery that, like other cosmetic eye procedures, is truly an art form.  How is it an art?  Consider how the best eye plastic surgeon must not only have education, training, and experience; he or she must also have the keen ability to perceive subtle characteristics that make your eyes and entire facial structure distinctive, the talent to design a treatment plan that addresses these features, and the skill to provide natural results and a fast healing time.  When one considers the complexity of cosmetic eyelid surgery, it is no wonder why it’s essential you seek a surgeon who individualizes your treatment.

What Should I Know about Ptosis and Asian Eyelids?

For whatever reason you seek treatment for Asian eyelid ptosis, first know that there is science-based treatment available that can improve your condition.  Please also understand that your treatment must be individualized for you as we discussed above.  The best cosmetic surgeon for you will be one who is a leader in Asian cosmetic eye surgery with a solid reputation and proven results.  Ptosis can affect anyone, and effective treatment must correct existing problems by enhancing the natural qualities of your eyelid contour.  In other words, correcting ptosis of the Asian eyelid is in no way about “westernizing” the eye, so talk to your doctor about his or her treatment philosophy to find someone who can establish the right results for you.

How Is Ptosis Treated?

With ptosis what we observe is a heavy or drooping eyelid.  This can cause aesthetic problems like asymmetry and even cause challenges with communication when people are focused on your eyelid ptosis rather than what you are saying.  It can also impede your peripheral vision and cause dissatisfaction with your appearance.

Any good treatment will be customized for your condition, goals, medical history, and unique features.  This may include eyelid surgery to remove excess upper eyelid skin, which corrects the imbalance of forehead activation needed to elevate this extra tissue.  You may be a candidate for a forehead lift that helps to brighten your eyes’ appearance and balance out your whole face.  Anchor blepharoplasty is another type of upper eyelid surgery that can correct ptosis of the eyelashes.  The right and best option for you can only be determined at a personal consultation with a leading oculofacial surgeon.

Schedule Your Consultation Today

For differentiated results that optimize your natural features and facial qualities, consider how Dr. Steinsapir can help.  Dr. Steinsapir practices oculofacial cosmetic surgery in Los Angeles and Beverly Hills.  Individuals travel from across the United States and world to benefit from his exceptional treatment practices.  Dr. Steinsapir is an eyelid specialist with expertise in treating Asian eyelid concerns like ptosis.  Contact us today to learn about how Dr. Steinsapir’s background and an individualized approach can be the perfect match for your eyelid concerns.

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